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Fever as an initial manifestation of spondyloarthritis: A retrospective study.

Authors
 Se Jin Byun  ;  William Han Bae  ;  seung Min Jung  ;  Sang-Won Lee  ;  Yong-Beom Park  ;  Jason Jungsik Song 
Citation
 PLoS One, Vol.12(9) : e0184323, 2017 
Journal Title
 PLoS One 
Issue Date
2017
MeSH
Adult ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Biomarkers/analysis ; Electronic Health Records ; Female ; Fever/epidemiology ; Fever/etiology ; Fever/immunology ; HLA-B7 Antigen/metabolism ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spondylarthritis/classification ; Spondylarthritis/drug therapy ; Spondylarthritis/immunology ; Steroids/standards ; Treatment Outcome
Abstract
OBJECTIVES: We aimed to evaluate a wide spectrum of clinical features of adult patients with spondyloarthritis (SpA) whose initial manifestation was fever, using the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHODS: We retrospectively collected the electronic medical records of hospitalized SpA patients who initially presented to the Severance Hospital (Seoul, Korea) with fever from January 2010 to May 2016. As a control group, we also recruited one-hundred consecutive patients who were diagnosed with SpA in our outpatient clinic. Clinical features and laboratory findings were compared in two patient groups. RESULTS: There were 26 patients who had fever as initial presentation of SpA (reactive arthritis 50%, undifferentiated SpA 26.9%, ankylosing spondylitis 15.4%, enteropathic arthritis 3.8%, psoriatic arthritis 3.8%). Peripheral SpA was more common in febrile SpA patients than in control SpA patients (65.4% vs 24.0%, p<0.001). Febrile SpA patients were less frequently HLA-B27 positive than control SpA patients (52.2% vs 77.0%, p<0.05). At baseline, systemic inflammatory markers were significantly higher in the febrile SpA patients (white blood cell count, 11.57 vs 7.81 cells/μL, p<0.001; erythrocyte sedimentation rate, 69.2 vs 41.0 mm/h, p<0.001; C-reactive protein, 109.6 vs 15.3 mg/L, p<0.001). The proportion of patients treated with systemic steroids was significantly higher in febrile SpA patients (57.7% vs. 11.0%, p<0.001). The proportion of patients who visited rheumatology specialty was significantly lower in febrile SpA patients than in control SpA patients (7.7% vs 59.0%, p<0.001). CONCLUSION: Various subgroups of SpA can be presented with fever as an initial manifestation. Febrile SpA patients demonstrated higher systemic inflammation and a lower chance to visit rheumatology in early stage. When evaluating febrile patients with any clinical features of SpA, clinicians are advised to consider performing SpA-focused evaluation including HLA-B27 or a simple sacroiliac joint radiograph.
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DOI
10.1371/journal.pone.0184323
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
박용범(Park, Yong Beom)
변세진(Byun, Se Jin)
송정식(Song, Jungsik Jason) ORCID logo https://orcid.org/0000-0003-0662-7704
이상원(Lee, Sang Won) ORCID logo https://orcid.org/0000-0002-8038-3341
정승민(Jung, Seung Min ) ORCID logo https://orcid.org/0000-0003-3465-2181
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160776
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